Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME63004 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | ME63004 | FL |
NPI | 1164431037 |
---|---|
Provider Name | Dr. Paul D. Zawatsky |
First Address | Jacksonville, FL 32257 |
Second Address | Jacksonville, FL 32257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 28/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84010 | (02) | FL |